WO2007093941A1 - Orthose et méthode de traitement - Google Patents

Orthose et méthode de traitement Download PDF

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Publication number
WO2007093941A1
WO2007093941A1 PCT/IB2007/050423 IB2007050423W WO2007093941A1 WO 2007093941 A1 WO2007093941 A1 WO 2007093941A1 IB 2007050423 W IB2007050423 W IB 2007050423W WO 2007093941 A1 WO2007093941 A1 WO 2007093941A1
Authority
WO
WIPO (PCT)
Prior art keywords
thermal treatment
treatment
orthosis
patient
electrical
Prior art date
Application number
PCT/IB2007/050423
Other languages
English (en)
Inventor
Gerd Lanfermann
Richard D. Willmann
Original Assignee
Koninklijke Philips Electronics N.V.
Philips Intellectual Property & Standards Gmbh
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Koninklijke Philips Electronics N.V., Philips Intellectual Property & Standards Gmbh filed Critical Koninklijke Philips Electronics N.V.
Priority to JP2008554891A priority Critical patent/JP2009526593A/ja
Priority to EP07705827A priority patent/EP1986580A1/fr
Priority to US12/279,230 priority patent/US20090012436A1/en
Publication of WO2007093941A1 publication Critical patent/WO2007093941A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F7/00—Heating or cooling appliances for medical or therapeutic treatment of the human body
    • A61F7/007—Heating or cooling appliances for medical or therapeutic treatment of the human body characterised by electric heating
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/36003—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation of motor muscles, e.g. for walking assistance
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00017—Electrical control of surgical instruments
    • A61B2017/00022—Sensing or detecting at the treatment site
    • A61B2017/00084—Temperature
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F7/00—Heating or cooling appliances for medical or therapeutic treatment of the human body
    • A61F7/007—Heating or cooling appliances for medical or therapeutic treatment of the human body characterised by electric heating
    • A61F2007/0075—Heating or cooling appliances for medical or therapeutic treatment of the human body characterised by electric heating using a Peltier element, e.g. near the spot to be heated or cooled
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F7/00—Heating or cooling appliances for medical or therapeutic treatment of the human body
    • A61F7/02—Compresses or poultices for effecting heating or cooling
    • A61F2007/0295—Compresses or poultices for effecting heating or cooling for heating or cooling or use at more than one temperature
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F5/00—Orthopaedic methods or devices for non-surgical treatment of bones or joints; Nursing devices; Anti-rape devices
    • A61F5/01—Orthopaedic devices, e.g. splints, casts or braces

Definitions

  • the invention relates to an orthosis, as well as to a method to treat a patient, for example to treat spasticity.
  • Orthoses as such are known from the prior art. Generally, an orthosis is applied to firmly support a part of a patient, for example a limb. A specific type of orthosis is the so-called FES orthosis. FES stands for 'functional electrical stimulation'. The FES orthosis can provide electrical stimulation of, for example, a muscle of a patient, for example to treat a certain spastic disorder.
  • the known orthosis system comprises a hand- forearm orthosis containing an array of electrodes, connected to an electronic microprocessor-controlled unit.
  • This known orthosis system can provide neuromuscular stimulation, for therapeutic treatment.
  • the system comprises a control unit, which sends pulses of low- level electrical current to the electrodes integrated into the orthosis.
  • the known unit initiates phased-patterned stimulation sequences to activate the muscles in selected order for functional or therapeutic exercise of the hand.
  • Functional modes and therapeutic treatment programs can be programmed into a microprocessor.
  • the known FES orthosis system has several disadvantages. Particularly, a respective FES treatment is usually not suitable to be applied continuously over a long time, since such a treatment can lead to muscle fatigue.
  • the orthosis comprises:
  • a rigid support device for example a rigid exoskeleton or a rigid frame, to support the patient and/or correct a posture of the patient during use;
  • -a system to provide electrical treatment for example a FES system to provide functional electrical stimulation; and -a system to provide thermal treatment.
  • the orthosis can be used to apply both a FES treatment and a thermal treatment to the patient, which can lead to considerably improved treatment results.
  • the orthosis can treat the patient for a relatively long time.
  • the orthosis can provide FES treatment and thermal treatment a suitable number of times, in a suitable order.
  • an embodiment of the invention provides a method to treat a patient, wherein the patient is provided with an orthosis according to the invention, such that the orthosis supports the patient and/or corrects a posture of the patient, wherein part of the patient, for example a muscle part, is electrically treated and thermally treated by the orthosis.
  • the method can involve treatment of a spastic disorder, and/or an other muscle disorder. This can provide the above-mentioned advantages, and can particularly lead to an improved treatment of the patient, for example to overcome spasticy in an effective manner.
  • a computer program or software, is provided, with instructions arranged for carrying out or controlling a method according to the invention when said program is executed by a computer, or hardware respectively.
  • a basic idea behind the present invention is, that a FES orthosis is equipped with a thermal treatment system, for example a heating or cooling element, to provide and coordinate additional muscle relieve therapies.
  • a thermal treatment system for example a heating or cooling element
  • Fig. 1 schematically depicts an embodiment of the invention, during use, wherein the orthosis is depicted in a cross-section;
  • FIG. 2 schematically depicts an alternative embodiment of the invention, during use, wherein the orthosis is depicted in a cross-section;
  • Fig. 3 schematically depicts a perspective view of an support part according to an embodiment;
  • Fig. 4 schematically shows a further embodiment of the invention, depicting part of an inner surface of the orthosis; and Fig. 5 schematically shows an other further embodiment of the invention, depicting part of an inner surface of the orthosis.
  • FIG. 1 schematically shows an embodiment of a FES orthosis, or orthotic support device, 1, during use.
  • the orthosis 1 is configured to be worn by a patient, particularly to treat a medical disorder of the patient, for example to treat a spastic disorder of a limb L.
  • a muscle, to be treated is schematically indicated in Fig. 1 by dashed lines M.
  • the orthosis is substantially carried by the forearm L of the user.
  • the orthosis can be configured to be carried by a different user limb to be treated, for example a leg, and/or an other user part, for example a torso.
  • the orthosis 1 comprises a rigid support device 2, for example a rigid exoskeleton, a rigid frame or an external brace, configured to support one or more parts of the patient and/or correct a posture of the patient.
  • a support device can be configured in various ways, as will be clear to the skilled person.
  • the support device 2 can be an exo- skeleton, which can attach to a user's limb L to support, stabilize, and correct the posture, or to monitor and assist in the execution of movements during rehabilitation.
  • the support device 2 can be configured to hold one patient part in a substantially fixed position with respect to an other patient part, for example to firmly hold and stabilize a joint.
  • the support device 2 can be configured to be attached or connected to the different parts of the patient, for example to a hand (or wrist) and the respective fore-arm to position the hand (or wrist) and fore-arm firmly with respect to each other. Also, for example, the support device 2 can be configured to counteract certain muscle contractions of the respective patient part L. Thus, also, the orthosis can be arranged to counteract movement of a limb or part of the patient.
  • the mentioned exo-skeleton can include one or more substantially rigid, or substantially non- flexible, frame members 2 (which are depicted schematically in Fig.
  • the frame members 2 can be made of various materials, can have various shapes, as will be clear to the skilled person.
  • the frame members 2 can comprise or consist of one or more rigid plastics, metals, alloys and/or other materials, rigid composite materials, fiber reinforced compositions and/or a combination of such and other materials.
  • the mentioned exo-skeleton may e.g. come as a tube 2, which can be opened e.g. along a long side, and which can hold the arm fixed, or support the arm, inside.
  • Fig. 1 shows a cut through such a system, with the arm and arm muscles in the center, substantially surrounded by the rigid structure 2 of the orthosis.
  • Fig. 3 shows a perspective sketch of a skeleton part of such a system, wherein the support part 4 is substantially tube-shaped.
  • the orthosis is provided with a system to provide electrical treatment of the limb L, for example a FES system to provide functional electrical stimulation of the muscle M.
  • the rigid support device 2 can be provided with one or more electrodes 11, connected or connectable to a power source 30, 32, particularly to apply high-frequency electric signals to trigger muscle activity of the patient during use.
  • Each of the electrodes 11 can be configured in various ways.
  • each electrode 11 is configured to make electrical contact with the skin of the user, to apply electrical treatment.
  • the orthosis 1 can comprise or be connectable to a controller 30, to control the electrical treatment system and/or the thermal treatment system.
  • the mentioned power source 32 can be part of the controller 30, and/or can be an external power source.
  • the application of the mentioned electric signals to the electrodes is controllable by the controller 30.
  • the controller 30, power source 32 and electrodes 11 can be communicatively connected to each other in various ways, for example by suitable wiring 19, and/or wirelessly, as will be clear to the skilled person.
  • the controller 30 can include suitable hardware, computer means, a personal computer, a portable controller, a PDA (personal digital assistant), microelectronics, a memory, a timer 33, and/or other controller means, as will be clear to the skilled person.
  • the controller 30 can be at least partly provided by software.
  • a computer program can be provided, or software, with instructions arranged for controlling at least part of the treatment when said program is executed by a computer, or hardware respectively.
  • treatment parameters relating to a treatment to be carried out, can be stored in the controller 30.
  • the controller 30 can be provided with, or can be coupled to, a suitable user interface 31, through which the user and/or a physiotherapist can activate, adjust and/or operate the controller.
  • the user interface 31 can be configured to allow a user or operator to adjust mentioned treatment parameters, and/or to program one or more functional modes and therapeutic treatment programs.
  • a (personalized) treatment protocol can be either stored or downloaded, for example utilizing a portable memory device, a Memory stick, floppy disk, using secure internet access to medical professional and/or in a different manner.
  • the controller 30 can be configured to access and apply the mentioned treatment protocol, to provide a desired treatment.
  • the orthosis 1 can comprise or be connectable to at least a first sensor
  • Such a first sensor 5 can be configured in various ways.
  • a sensor 5 can include one or more strain or pressure gauges, which can be configured to determine muscle activity or muscle contractions of/in the respective part (limb L) of the patient.
  • a sensor can be configured to derive the effects of the electric treatment physiologically by deriving an EMG (electromyogram).
  • EMG electrometic electrowetting machine
  • such sensor 5 is connected or connectable to the mentioned controller 30, for example to provide measurement results to the controller and/or to be powered by the controller.
  • the orthosis 1 is provided with a system to provide thermal treatment of the limb L.
  • This thermal treatment system can be configured in various ways.
  • the orthosis can be configured to carry a thermal treatment device 20.
  • the thermal treatment device 20 can be configured to exchange heat with a respective user's limb L to thermally treat the limb L.
  • the thermal treatment device can comprise a suitable thermal treatment agent.
  • the thermal treatment system includes a cooling system, wherein the treatment device 20 is a cooling device, and comprises a cooling agent, for example a freezable cooling agent, during use.
  • the cooling system can provide cooling, particularly to cool one or more muscles M of a part of the patient, which carries the orthosis 1 during use.
  • the cooling system can be configured to provide a cooling of the limb's skin surface to 15-20 degrees Celsius, or to lower temperatures, during a desired treatment period.
  • a cooling can allow the orthosis 1 to cool the limb L during a thermal treatment session of an overall treatment, for example to relax muscle contractions.
  • the mentioned thermal treatment device 20 can be configured or operate, for example, similar to the cooling device of the depilation system described in US patent US 6,406,483 Bl, which patent is incorporated in the present application by reference.
  • the cooling agent can comprise or consist of a mixture comprising water, a coloring agent, and a preserving agent.
  • the thermal treatment system can also be configured to provide a certain heating of the patient, for example to warm one or more muscles M of a part L of the patient which carries the orthosis 1 during use.
  • the thermal treatment device 20 can be provided with a heat able heating agent instead of a cooling agent.
  • the thermal treatment system can then be configured or operate, for example, similar to the heating device of the depilation system described in US patent US 6,689,143 Bl, which patent is incorporated in the present application.
  • the heating agent can be a compound having a eutectic composition.
  • the thermal treatment system can comprise a heating member 20 for generating a rise in temperature of the skin.
  • the thermal treating system can comprise an electrical heating system (for example comprising one or more electric heaters, and/or Peltier elements 120, see below), to electrically heat at least part of, for example, a limb L (or the skin thereof) to be treated.
  • the thermal treatment device comprises a housing or casing 20 in which a certain quantity of a thermal treatment agent (not depicted) is or can be contained.
  • the housing 20 is removable coupled to the support device 2, so that the housing 20 can be cooled or heated separately.
  • the housing can be cooled in a separate freezing device, for example in a freezer compartment of a refrigerator or a home freezer.
  • the orthosis can be provided with one or more skin contact areas 23, to provide thermal contact with the patient during use, particularly to receive heat from the patient and/or to supply heat to the patient.
  • a heat conductor 22 can be provided, to conduct heat between a skin contact part or area 23 and the mentioned housing 20.
  • a mentioned skin contact area 23 is configured to extend opposite the muscle part M of the limb, along the user's skin, during use.
  • the skin contact area 23 is shown to substantially surround part of the arm of the user.
  • the skin contact area 23 can provide a peripheral thermal treatment of the limb L.
  • the skin contact area 23 can be configured to abut various sides of the user's skin, and/or to substantially surround the limb L.
  • the orthosis 1 can be provided with one or more skin contact areas in various ways. Figures 4-5 show other embodiments, with different arrangements of skin contact areas, as will be explained below.
  • the orthosis can be provided with one or more of the mentioned heat conductor 22.
  • Each heat conductor 22 can be fixed to the support device 2, and/or be made in one part with the support device 2.
  • the heat conductor 22 can be connected to, or be part of the housing 20.
  • the heat conductor 22 can be made of one or more materials having a relatively high thermal conductivity, for example one or more metals, aluminum and/or different materials.
  • a mentioned skin contact part or area 23 of the heat treatment system can be a surface part of the heat conductor 22, or be connected or connectable to the heat conductor 22.
  • the skin contact part area 23 can be of the made material as the heat conductor 22, of different material.
  • the housing 20 can be in a suitable thermal contact with the heat conductor 22, for example to receive heat from the patient's skin that abuts the mentioned skin contact part 23 to provide cooling treatment of a muscle part M, or to apply heat to the skin in a heating treatment to heat the muscle part M.
  • FIG. 2 shows an alternative embodiment.
  • the thermal treatment system including at least one Peltier element 120.
  • the Peltier element 120 can be controlled by the controller 30, to cool or heat the limb L of the patient.
  • the skin contact area 23 can be actively cooled down, or alternatively warmed up, by means of the one or more Peltier elements 120.
  • the orthosis can be configured to apply one or more such Peltier elements 120 in conjunction of a mentioned thermal treatment agent.
  • the skin contact area 23 of the thermal treatment system can be located and/or extend between mentioned electrodes 11 of the electrical treatment system.
  • the electrodes 11 are arranged next to the skin contact area 23 for thermal treatment.
  • the orthosis can be configured to apply electrical treatment and thermal treatment at least to substantially the same muscle part M of the patient during use, for example to hand muscles M which are located in the fore-arm.
  • the electrodes 11 and the skin contact area 23 of the thermal treatment system are arranged to make contact with different skin surfaces at the same time, when the orthosis 1 is being worn by the patient.
  • interference between heat treatment and electrical treatment can be prevented.
  • electrodes 11 can be kept relatively free of undesired condensing water, for the case that a cooling treatment was or is performed as well.
  • the one or more electrodes 11 and the one or more skin contact areas 23 can be separate from each other, or at least partially overlap, and/or can be at least partially integrated with each other.
  • the orthosis 1 can comprise one or more second, thermal, sensors 25, for example to detect a result of a mentioned thermal treatment and/or to monitor the thermal treatment.
  • the monitoring can involve, for example, timing the time period during which a certain thermal treatment is still present, and/or detecting an amount of thermal treatment.
  • the monitoring can also involve detecting a certain end of a thermal treatment, for example in case the at least one thermal sensor 25 detects a predetermined threshold temperature which relates to an effective ending of the thermal treatment .
  • a thermal sensor 25 can be provided, for example, to measure temperature at or near a skin contact area 23 of the thermal treatment system, and/or the measure the temperature of the skin of the user.
  • one or more such temperature sensing means 25 can be configured to measure a temperature of part of the orthosis 1, to measure a temperature of a mentioned thermal treatment agent, or to measure a temperature of the environment of the orthosis 1.
  • the controller 30 preferably receives sensor signals from such one or more thermal sensors 25.
  • the orthosis 1 can be configured to automatically alternate electrical treatment and thermal treatment. The alternating of the treatments can be, for example, abruptly, or gradually such as via ramping.
  • the orthosis 1 can be configured to apply the electrical treatment and thermal treatment at least partially at the same time.
  • the controller 30 can control both the electrical treatment system and/or the thermal treatment system, and can carry out a desired treatment schedule.
  • the controller can be a mentioned timer 33, to automatically start, adjust and/or stop the electrical FES treatment at one or more predetermined times during operation.
  • a FES session can be automatically stopped after a predetermined time period, to prevent muscle fatigue.
  • a mentioned electrical heating system or a mentioned Peltier element to automatically start, adjust and/or stop the electrical FES treatment at one or more predetermined times during operation.
  • a FES session can be automatically stopped after a predetermined time period, to prevent muscle fatigue.
  • the thermal treatment 120 can be timer controllable by the controller 30.
  • the thermal treatment can be activated , adjusted and/or deactivated at desired, suitable times.
  • the amount of thermal treatment, provided by such an electrical thermal treatment system 120 can be controlled and adjusted in a well-defined manner.
  • the thermal treatment system can provide multiple heating or cooling sessions, for example at least one session before and at least one session after each FES treatment of the electrical treatment system.
  • the one or more Peltier elements 120 can also provide thermal treatment during a mentioned electrical FES treatment.
  • the controller 30 is preferably configured to control the electrical treatment system and/or the thermal treatment system, using one or more parameters, such, that one or more parameters concerning the electrical treatment and one or more parameters concerning the thermal treatment are mutually dependent. Thus, an optimum or well-balanced treatment may be reached, leading to improved results.
  • the orthosis 1 can treat the patient, wherein the limb of the patient is provided with the orthosis 1, such that the orthosis 1 supports the patient and/or corrects a posture of the patient.
  • the housing 20 can first be externally cooled in a freezer, to cool a thermal treatment agent. Then, the housing 20 can be attached to the orthosis 1, to provide the cooling treatment of the muscle M. The thermal conductor 22 can then ensure good heat transport between cooling agent in the housing 20 and the contact area for the skin 23, to cool the skin and to thermally treat the muscle M.
  • the thermal treatment system of the orthosis can be used to provide a certain (active) heating of the limb L, for example by providing a heating agent instead of a cooling agent, as is mentioned above.
  • the use of the embodiment of Fig. 2 can be similar to the use of the embodiment of Fig. 1.
  • the one or more Peltier elements 120 can be activated to provide the thermal treatment, instead of (or -if applicable- in addition to) the use of a cooling or heating agent.
  • the electrical treatment system can provide a certain FES treatment of the muscle M, via the electrodes 11.
  • the overall treatment which includes both the thermal treatment and the FES treatment, can be substantially automated, and can be under the control of the controller 30.
  • the muscle part M of the limb L can be electrically treated and thermally treated by the orthosis 1 , for example to treat a spastic disorder.
  • the thermal treatment and electrical treatment can be applied at least partially at the same time, if desired.
  • the thermal treatment and electrical treatment can be timed, and/or controlled automatically, by a mentioned timer 33.
  • the thermal treatment can be started, by controller 30, a predetermined amount of time before the electrical treatment is started.
  • the thermal treatment can be automatically started or maintained during a predetermined amount of time, after electrical treatment has stopped.
  • the length of the electrical treatment is preferably under timer control.
  • one or more parameters concerning the electrical treatment and one or more parameters concerning the thermal treatment can be mutually dependent.
  • the method can comprise measuring or determining an effect of the electrical treatment, and using the result of such a measurement or determination to control or adjust the thermal treatment.
  • a controlling of the treatment systems is dependent of results provided by one or more of the above-mentioned sensors 5, 25.
  • the controller 30 can be configured to start, change or increase a FES treatment, provided via the electrical treatment system, in case a mentioned thermal sensor 25 has detected a certain decrease of a mentioned thermal treatment, provided by the thermal treatment system, and/or in case a sensor signal of the thermal sensor 25 passes a certain predetermined threshold value.
  • the controller 30 can be configured to start, change or increase a thermal treatment, provided via the thermal treatment system, in case a mentioned first sensor 5 has detected a certain decrease of a mentioned electrical treatment, provided by the electrical treatment system, and/or in case a sensor signal of the first sensor 5 passes a certain predetermined threshold value.
  • the treatment, provided by the orthosis 1 can be controllable in a different manner and order.
  • Fig. 4 shows an alternative embodiment, which differs from the embodiments shown in Figures 1-2 in that the orthosis is provided with multiple skin contact areas 123, to provide a heating/cooling.
  • Fig. 4 provides a view towards part of an surface of the orthosis, which surface is faced towards the skin of a user during use.
  • Fig. 4 depicts mentioned electrodes 11 as well as a number of the skin contact areas 123.
  • the electrodes 11 are each surrounded by a plurality of the skin contact areas 123.
  • the several skin contact areas 123 can be heated and/or cooled independently.
  • the shape of these skin contact areas 123 or units may be designed according to match a location and extension of one or more targeted muscles M.
  • the orthosis can be provided with independent thermal sources for each skin contact area 123.
  • the control of each skin contact area 123 e.g. is done depending on the stimulation through the individual electrodes 11.
  • Fig. 5 shows an other alternative embodiment, which differs from the embodiments shown in Figures 1-2 in that the orthosis is provided with an array of skin contact areas 223, to provide a heating/cooling.
  • Fig. 5 also provides a view towards part of the inner surface of the orthosis, and depicts mentioned electrodes 11 as well as the array of skin contact areas 223.
  • the skin contact areas 223 are substantially parallel to each other.
  • the electrodes 11 are each surrounded by two of the skin contact areas 223 of the array.
  • the skin contact areas 223 of the array can be heated and/or cooled independently.
  • the orthosis can be provided with independent thermal sources for each skin contact area 223.
  • the control of each skin contact area 223 e.g. can be done depending on the stimulation through the individual electrodes 11. With such a system, the individual muscle location and extension could easily be matched by turning on/off the respective skin contact areas.
  • the present orthosis 1 can provide a very effective treatment of, for example, spasticity.
  • the additional cooling of a spastic limb L can provide additional and extended improvement.
  • the orthosis 1 can be used for home rehabilitation.
  • Spasticity is a disorder of the body's motor system in which certain muscles are continuously contracted. This contraction causes stiffness or tightness of the muscles and may interfere with gait, movement, and speech. Spasticity is usually caused by damage to the portion of the brain or spinal cord that controls voluntary movement.
  • the electrical treatment can involve applying high-frequency electric currents through the electrodes 11, to trigger muscle activity.
  • pulses of low- level electrical current can be sent to the electrodes 11 , to initiate phased-patterned stimulation sequences to activate the muscle(s) M in selected order for functional or therapeutic exercise of the hand.
  • Triggering the antagonistic muscle opens up the spastic contraction.
  • the thermal treatment system can cool the muscle M, to relax the contraction.
  • the present orthosis can provide integration of a cooling system into an FES orthosis, to provide advantages of both cooling and FES, for example whenever a stimulation session is initiated by the patient or a physiotherapist.
  • the one or more cooling areas 23 can make contact to the skin of the patient, and can be activated, when a FES session is initiated by the patient or the physiotherapist.
  • the present embodiment 1 can be carried for a long time, continuously, by the patient.
  • the orthosis 1 can treat the limb L over a long time period, by combining thermal treatment with FES treatment, for example in appropriate order.
  • FES treatment for example in appropriate order.
  • undesired muscle fatigue can be prevented well.
  • the application of separate cooling cushions first, before the orthosis 1 is being applied to the limb, can be prevented.
  • Such separate cooling cushion might interfere with FES treatment.
  • Application of separate cooling cushions could, for example, make the skin wet due to condensing water, hindering a subsequent FES treatment.
  • the present orthosis 1 can provide an easy way for a patient for an automated combination therapy.
  • the integration of a cooling device into the FES orthosis 1 can offer the following advantages, some of which are also mentioned above. Firstly, cooling and electrical stimulation can be applied at the same time: whenever the FES device is used, the muscle is cooled as well. Also, cooling can be integrated into a common treatment protocol. FES and cooling can automatically be scheduled, via the controller 30 and/or timer 33, without removing one of the two systems (FES , cooling). Cooling can be provided before the FES treatment: e.g. 2 hours before to FES phase is scheduled. The muscle is cooled in preparation of the FES session.
  • cooling can be provided after the FES treatment: after the electrical stimulation has been applied to the arm, die muscle is cooled to extend the benefit.
  • cooling can be automatically provided between the FES sessions.
  • cooling parameters temperature, duration
  • a reduced FES strength can be compensated by increased cooling with respect to a lower temperature and extended cooling duration.
  • the cooling parameters may be defined based on the response of the muscle to FES.
  • the effects of the FES may be determined mechanically, e.g. the ability of the muscle to contract (through strain gauges 5 around the arm).
  • FES parameters may set depending on cooling parameters.

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  • Health & Medical Sciences (AREA)
  • Veterinary Medicine (AREA)
  • Public Health (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Vascular Medicine (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Physical Education & Sports Medicine (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Radiology & Medical Imaging (AREA)
  • Thermotherapy And Cooling Therapy Devices (AREA)
  • Electrotherapy Devices (AREA)

Abstract

L'invention concerne une orthose configurée pour être portée par un patient, pour traiter, en particulier, un trouble médical chez un patient, l'orthose (1) consistant en : - un appareil de support rigide (2), par exemple un exosquelette rigide ou un cadre rigide, pour supporter le patient et/ou corriger la posture d'un patient pendant son utilisation ; - un système (11) de traitement électrique, par exemple un système FES pour permettre une stimulation électrique fonctionnelle ; et - un système (20) de traitement thermique.
PCT/IB2007/050423 2006-02-17 2007-02-09 Orthose et méthode de traitement WO2007093941A1 (fr)

Priority Applications (3)

Application Number Priority Date Filing Date Title
JP2008554891A JP2009526593A (ja) 2006-02-17 2007-02-09 装具及び処置方法
EP07705827A EP1986580A1 (fr) 2006-02-17 2007-02-09 Orthose et méthode de traitement
US12/279,230 US20090012436A1 (en) 2006-02-17 2007-02-09 Orthosis and treatment method

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EP06110083 2006-02-17
EP06110083.0 2006-02-17

Publications (1)

Publication Number Publication Date
WO2007093941A1 true WO2007093941A1 (fr) 2007-08-23

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PCT/IB2007/050423 WO2007093941A1 (fr) 2006-02-17 2007-02-09 Orthose et méthode de traitement

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Country Link
US (1) US20090012436A1 (fr)
EP (1) EP1986580A1 (fr)
JP (1) JP2009526593A (fr)
CN (1) CN101384232A (fr)
WO (1) WO2007093941A1 (fr)

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DE102014221474A1 (de) * 2014-10-22 2016-04-28 Pohlig Gmbh Wärme-/Kühl-Element
IT201900018770A1 (it) * 2019-10-15 2021-04-15 Green Working For Dev Of The World Dispositivo medicale, fisioterapico e/o protettivo di tipo indossabile

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EP3067022A1 (fr) 2008-02-05 2016-09-14 Compex Medical S.A. Attelle de stimulation
US10195430B2 (en) 2008-02-05 2019-02-05 Djo, Llc Stimulation brace
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DE102014221474A1 (de) * 2014-10-22 2016-04-28 Pohlig Gmbh Wärme-/Kühl-Element
IT201900018770A1 (it) * 2019-10-15 2021-04-15 Green Working For Dev Of The World Dispositivo medicale, fisioterapico e/o protettivo di tipo indossabile
EP3808319A1 (fr) * 2019-10-15 2021-04-21 Green Working for the Development of the World S.r.l. - in Sigla GWDW Dispositif médical, physiothérapeutique et / ou protecteur portable

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EP1986580A1 (fr) 2008-11-05
CN101384232A (zh) 2009-03-11
US20090012436A1 (en) 2009-01-08
JP2009526593A (ja) 2009-07-23

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